Exercise testing to guide safe discharge from hospital in COVID-19: a scoping review to identify candidate tests

OBJECTIVES: We aimed to identify exercise tests that have been validated to support a safe discharge to home in patients with or without COVID-19. STUDY DESIGN: Scoping review, using PRISMA-ScR reporting standards. Medline, PubMed, AMED, Embase, CINAHL and LitCovid databases were searched between 16 and 22 February 2021, with studies included from any publication date up to and including the search date. INTERVENTION: Short exercise tests. PRIMARY OUTCOME MEASURES: Safe discharge from hospital, readmission rate, length of hospital stay, mortality. Secondary outcomes measures: safety, feasibility and reliability. RESULTS: Of 1612 original records screened, 19 studies were included in the analysis. These used a variety of exercise tests in patients with chronic obstructive pulmonary disease, suspected pulmonary embolism and pneumocystis carinii pneumonia, heart failure or critical illness. Only six studies had examined patients with COVID-19, of these two were still recruiting to evaluate the 1 min sit-to-stand test and the 40-steps test. There was heterogeneity in patient populations, tests used and outcome measures. Few exercise tests have been validated to support discharge decisions. There is currently no support for short exercise tests for triage of care in patients with COVID-19. CONCLUSIONS: Further research is needed to aid clinical decision-making at discharge from hospital.